Provider Contract Operations Specialist

Provider Contract Operations Specialist page is loaded## Provider Contract Operations Specialist locations:
Miami, FL:
Fort Lauderdale, FL:
Miramar, FLtime type:
Full time posted on:
Posted Todayjob requisition :
R-406118#
** Become a part of our caring community and help us put health first
** The Provider Contract Operations Specialist/ Provider Contracting Professional 2 initiates, negotiates, and executes physician, and/or other provider contracts and agreements for an organization that provides health insurance. You will report to the Director Provider, Contracting.

Provider Contract Operations Specialist **/
** Provider Contracting Professional 2 you will
* Analyze financial impact of contracts and terms.
* Maintain contracts and documentation within a tracking system.
* May assist with identifying and recruiting providers based on network composition and needs.
* Communicate contract terms, payment structures, reimbursement rates to providers internal and external members
* Negotiate and maintain contracts with MSO or primary care providers to ensure our network meets regulatory and business requirements.
* Manage relationships with key providers to support member access, minimize disruption, and maintain competitive advantage.
* Ensure contract terms are implemented and that our organization is protected from risk, both financially and legally.
* Support cross-functional teams with updates on contracting status, rate changes, and network developments.#
** Use your skills to make an impact
**** Required Qualifications
*** 2 or more years of experience in negotiating or servicing HMO managed care contracts
* Proficiency in Understanding of contract terms, payment structures and reimbursement rates
* Experience with public speaking or presentation skills and with provider facing communication
* Experience with Value-based Contracting
* Proficiency in MS Office Word and Excel (IE pivot tables, formulas, v-look up)
* Live in Broward, Dade, Palm Beach County
** Preferred Qualifications
*** Bachelor's degree
* Experience with ACO / Risk Contracting
* Bilingual (English/Spanish)
** Additional Information
** This role is Hybrid:
Work at home with Weekly Travel at least 40% to Provider facing meetings based on business needs
** Hire Vue
* * As part of our hiring process for this opportunity, we will be using an interviewing technology called Hire Vue to enhance our hiring and decision-making ability. Hire Vue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule.
** Work at Home
** To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria:
* At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership.
* Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense.
* Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job.
* Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information.#LI-BB1

Travel:
While this is a remote position, occasional travel to Humana's offices for training or meetings may be required.
** Scheduled Weekly Hours
** 40
* * Pay Range
** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc.$65,000 - $88,600 per year

This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance.
** Description of Benefits
** Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.#

About Care Plus Health Plans:
Care Plus Health Plans is a recognized leader in healthcare delivery that has been offering Medicare Advantage health plans in Florida over 23 years. Care Plus strives to help people with Medicare, or both Medicare and…